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Author Topic: THR but want BHR  (Read 4932 times)

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gasyz

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THR but want BHR
« on: November 06, 2013, 03:33:18 PM »
Hi.new to this but need some feedback quickly.I,m booked in for a ceramic THR on 19th nov and very concerned about it.I would like to have a BHR but the hospital no longer offer them,stating that they are no good.I'm very active (mountainbike motocross)and feel the BHR would be a better option for me at 42 years.What can I do? please help
Rbhr 60/54
Ronan Treacy, 5th September 2015

Miguelito

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Re: THR but want BHR
« Reply #1 on: November 06, 2013, 03:51:32 PM »
Ultimately you are the one who needs to decide which device you get, HR or THR. In my experience there are very few docs who will tell patients that they are agnostic as to device. They are for one or the other. Now I am sure a lot of this has to do with other factors (hospitals must have some influence on doctors selection of method/device) but the bottom line is that you have to pick the device, then find a qualified doctor who will do the surgery.

If you want a BHR then you need to cancel your surgery and continue shopping. I hope that your insurance/budget allows you to get what you want.
RHR April 2012.
LHR March 2014.

Both Biomet Magnum/Recap 54/48, by Dr. Thomas Gross.

obxpelican

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Re: THR but want BHR
« Reply #2 on: November 06, 2013, 04:08:07 PM »
If you desire a hip resurfacing the only thing you can do is call and cancel, but first ask your doctor for a meeting and specifically ask what your limitations will be with the THR device you will be receiving.  In most cases people don't ask enough questions then when the surgery is over your doc ends up telling you that you are severely limited in what you can do.

Some devices will allow you an active life, many don't.  Once you have the surgery and the head of your femur is gone you cannot go back so think before you act.


Chuck



Hi.new to this but need some feedback quickly.I,m booked in for a ceramic THR on 19th nov and very concerned about it.I would like to have a BHR but the hospital no longer offer them,stating that they are no good.I'm very active (mountainbike motocross)and feel the BHR would be a better option for me at 42 years.What can I do? please help
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

gasyz

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Re: THR but want BHR
« Reply #3 on: November 06, 2013, 04:34:51 PM »
Thanx for input,I've managed to get an appointment with Mr Ronan Treacy to discuss BHR,my doctor doesn't seen very amused, but after reading this forum I think it's my best option.I'm really depressed at the thought of a THR and having to pack up a lot of my hobbies.Like  obxpelican said once the head is cut off theres no going back.I think I would rather carry on in pain for now than risk it at the moment.The biggest fear with THR is dislocation and it just doesn't look as strong to me.
Rbhr 60/54
Ronan Treacy, 5th September 2015

hernanu

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Re: THR but want BHR
« Reply #4 on: November 06, 2013, 05:16:44 PM »
I think you're smart to check out all of your options. Mr. Treacy is highly skilled and capable, he will let you know whether you are a good candidate for HR and is one of the best in the world at doing the procedure.

We are not here in this world to amuse our doctors. If they want to be amused, let them go catch a movie.

They are paid consultants to us with specialized skills; in the end we are the ones to live with the results of the choices made, the best thing to do is to make sure all choices are considered and a good decision is reached.

Chuck has given you good advice in my opinion (as he always does).
« Last Edit: November 06, 2013, 05:18:11 PM by hernanu »
Hernan, LHR 8/24/2010, RHR 11/29/2010 - Cormet, Dr. Snyder

HippyDogwood

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THR but want BHR
« Reply #5 on: November 06, 2013, 06:20:27 PM »
Gasyz

Do I take it you are also in the UK?

I have seen 3 surgeons;

First - stunned me by saying I was way beyond a scope and that I had maybe 2 years to THR
Second - was a referral from the first who specialised in scopes on "lost causes". He confirmed that scope was not an option and could only offer a THR and was very negative about HR
Third - was a surgeon I found through this site who has performed 1000+ HR's and gave a very honest appraisal of the pros and cons, concluding that whilst he could offer both HR & THR he thought HR was a better option for me when I feel the time has come

Now the point of this story is that surgeons 2 & 3 are amongst THE pre-eminent hip surgeons in the UK, yet have a completely conflicting view.

As others have said, you have to take control of the situation and go to see as many surgeons and ask as many questions as it takes to be comfortable with what YOU decide. IMHO this is not a black and white topic as with any surgery there are risks. THR has shortcomings such as longevity of device and more limitations on activity BUT does not carry the risk of metallosis which is getting all the bad press and causes your body to reject the device.

This is a calculated risk in that it happens on few occasions for those who are well suited to HR, but it does happen and you will read on this forum of a well suited meber facing correction after only 4 months.

Who cares what your doctor thinks as you have to live with the consequences, not him, so take your time and get it right so you never look back wishing you had gone about things a different way

gasyz

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Re: THR but want BHR
« Reply #6 on: November 06, 2013, 06:40:03 PM »
Yes I am in the uk.Seems to me not many NHS hospitals are doing Resurfacing anymore.Apart from Birmingham orthopaedic what are the other options?
Rbhr 60/54
Ronan Treacy, 5th September 2015

whyme

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Re: THR but want BHR
« Reply #7 on: November 06, 2013, 08:12:36 PM »
Adding to the other posts, this is my view.
First, there is a risk with any surgery and it's an irreversible process (you cannot undo a HR or THR), that's why we all got anxious before taking the step. But once the OA is bad enough, the "not surgery" option is gone, you've to do it. We all hoped (I did) that a new/miracle less invasive solution would come up not requiring a hip replacement (HR or THR), but we are still far from that.

Second, it's not straightforward, there are pros and cons to both HR and THR:
- THR is a well proven technique, it should last a long time in normal conditions, it's more immune to surgeon skill it seems and generally suitable to most patients, the chance of your body rejecting it (including metal reactions -unless is Metal on Metal-) is lower, and allows for good level of activity, but impact sports are NOT recommended. Revision (more likely for young patients) can be done, but there is less bone stock after the primary THR.
Of course, there are a few types of THR devices, with varying materials both in the acetabular cup and the femoral component, and that's an important consideration. It seems ceramic THR are among the favorite now.
So it's a safe, sound procedure, that works well for daily life and allows you to go back to an active life, but is not as suitable for very high level of activity (in particular impact sports).

- HR on paper resembles better the original hip joint, preserves more bone, theoretically it can last a long time (however the records only go as far as 15 years or so at this point) and a potential revision should be a reasonably straightforward primary THR.
It allows for a high level of activity (potentially), including impact sports (running, soccer, martial arts...).
However, it is a technically difficult procedure, with a steep learning curve for surgeons until they master it (and they must keep doing it over time). The results depend on surgeon skill and experience, correct device placement, device design, and patient selection (it seems gender and cup size are relevant factors, also the hip must be in relatively good condition for this to work; and patients with certain conditions like Avascular Necrosis, big osteophytes, severe dysplasia, low bone density etc might not always be ideal candidates).
Also, there is a risk of allergic reactions to metal, of two types: One, there is people allergic to metal, full stop (this is very rare and hard to find in pre-op tests); and two, metal debris (due to incorrect device placement, and bad device designs -like the infamous ASR model-) can cause serious problems and lead to a revision within 5 years or so.
The statistics show mixed or less than ideal results when compiling all HR records together, but once you filter out the bad devices (some already being retired from the market) and the surgeons not specialized in HR (i.e. those that do less than 50 or 100 a year and with less than hundreds of them overall), there is a subset of surgeons whose statistics are really good.

So for me it was:
- THR is "safe" but would limit my high expectations regarding sporting activities.
- HR is more "risky" (less margin for error), but would allow to live a very active life.
- The HR risks are minimized by choosing a specialized HR surgeon with vast experience and good track record (who would assess my suitability, select the right device and place it correctly). If things go wrong, I fall back to a THR.
I went for HR.

Regarding HR devices, BHR seems to be on top of the stats. However it's not the only good one. Also, the surgeon's experience with each device counts. My surgeon has been using BHR and Conserve Plus for years (he has done around 2000 of each), he used Conserve Plus for me (and I believe is his preferred now in most cases).
Of course, in the UK they will be a bit more biased towards BHR as it was invented there and naturally (I assume) most specialized HR surgeons are trained on it.
Left hip resurfacing (Conserve Plus) 2013-09-04
Dr. De Smet

johns567

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Re: THR but want BHR
« Reply #8 on: November 06, 2013, 08:16:59 PM »
I was in the same situation (46 yrs old) and visited 3 other surgeons that ONLY recommended THR simply because they do not do HRs. Do your research and take your time if you can.
I finally decided to use Dr. Schmalzried in Los Angeles which is 50 miles from where I live.

lgbran

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Re: THR but want BHR
« Reply #9 on: November 06, 2013, 08:48:14 PM »
Was in a similar situation here in Australia,
First surgeon only performed THR wasn't trained in BHR and totally opposed to the procedure, so asked for a referral to another surgeon, who explained the pros and cons of both and the decision was mine. After doing more research I cancelled my surgery with the second surgeon and now 4 days away from having my RBHR performed by a surgeon recommended on this site. Had no issues with the second surgeon. Close to home but hadn't performed the high numbers of the surgeon I decided to of with. I am 50 , still cycling 100- 200 ks a week but in a lot of pain. Eventually I would love to incorporate some long distant running again. Regardless of the outcome the decision is mine and at the end of the day I just want to be pain free and active. Down the track the THR is another option /alternative. I am so glad that I hunted around until I was totally happy with my decision.
All the best
RBHR 11/11/13 by Stephen McMahon @
The Avenue Hospital Melbourne Australia

gasyz

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Re: THR but want BHR
« Reply #10 on: November 06, 2013, 09:23:07 PM »
Many thanx for all the input,so glad I found this forum,Gonna push hard for a BHR,Feeling so upset at thought of THR at my age and limiting sport.My state of mind at the moment is if I can't get a BHR I'll go on as long as I can before a THR.Last month I did a 2 hour extreme enduro(motorbike) go practicing every sat and 2 hours mountainbiking with a club every week as well as the odd 30k xc ride.I'm in pain quite a lot but can't handle the thought of having to give everything up.Don't drink don't smoke,sport is what I live and work for.
Hopefully everything goes well with the Mr Treacy BHR consultation.
Rbhr 60/54
Ronan Treacy, 5th September 2015

Granton

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Re: THR but want BHR
« Reply #11 on: November 06, 2013, 10:27:00 PM »
Re. NHS and resurfacing. I just got a BHR with Mr McMinn under the NHS's Choose and Book system. Your local CCG could have special rules about them, but mine raised no objections.

The procedure was carried out in a private hospital.

You will be seeing one of the very top surgeons with Mr Treacy and if you are a good candidate for BHR, that is what you will get.
David
Rt BHR Nov 1999
Lt BHR Oct 2013
Mr D McMinn

toby

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Re: THR but want BHR
« Reply #12 on: November 06, 2013, 10:45:34 PM »
Whyme,
Great post-so brilliantly balanced and articulated for prospective hippies.

Gasyz,
After all the research I did, I wanted to return to sport and could see no reason why to amputate a perfectly healthy femoral head/neck. Despite the UK media last week the success rate of HR is excellent. Indeed, my surgeon (Prof Cobb) said to me 4 years ago that with all we know now re-patient selection/device placement etc HR will last a lifetime.
I guess that you are unable to pay privately-if so I do hope that Ronan Treacy is still able to do BHR on the NHS.
Please let us know.
Toby
LHR Adept-Prof Cobb-30-1-10

toby

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Re: THR but want BHR
« Reply #13 on: November 06, 2013, 10:49:53 PM »
Just read Granton's post just after I sent mine.
BHR-NHS-Mcminn, doesn't come better!
Toby
LHR Adept-Prof Cobb-30-1-10

obxpelican

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Re: THR but want BHR
« Reply #14 on: November 07, 2013, 01:57:03 AM »
If you can get Treacy to give you a BHR, buddy, you will be set, and probably for life.

With a hip resurfacing you will then get a 2nd chance, that is if for some crazy reason the BHR fails you can go to a THR (I seriously doubt it will fail).

I am of the opinion now, if you pick a good surgeon you will probably have a great chance of taking your device to the grave.

I'm 5 years out and I've never looked back and most days I forget I have an implant till I come here.   ;D 

When I went to my GP he thought I was nuts not getting what almost all doctors were giving their patients here in Pittsburgh, PA, a THR, so screw your doctor no matter what he thinks, pick the device that will give you the best results.

Good luck with Treacy.

Chuck


Thanx for input,I've managed to get an appointment with Mr Ronan Treacy to discuss BHR,my doctor doesn't seen very amused, but after reading this forum I think it's my best option.I'm really depressed at the thought of a THR and having to pack up a lot of my hobbies.Like  obxpelican said once the head is cut off theres no going back.I think I would rather carry on in pain for now than risk it at the moment.The biggest fear with THR is dislocation and it just doesn't look as strong to me.
Chuck
RH/Biomet U/C Dr. Gross/Lee Webb
8-6-08

Barbara

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Re: THR but want BHR
« Reply #15 on: November 07, 2013, 04:45:29 PM »
I know of many who have had problems with Resurfacing. I would go with something tried and tested.
 Good luck with whatever you choose.

http://www.depuyhiprecallnewscenter.com/updates/united-kingdom-bans-metal-on-metal-hip-implants-from-hospitals/

Barbara
RBHR 10/13/2008. LBHR 12/08/2008. LBHR revision 1/18/2010, LTHR 9/23 2011, RTHR 12/16 2011............
Dr Pritchet, Seattle

chuckm

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Re: THR but want BHR
« Reply #16 on: November 07, 2013, 04:54:12 PM »
Barbara, this forum has been discussing that same article since it came out.
Why did both of your BHR's need revision?

Chuckm
Left BHR 11/30/12
Hospital for Special Surgery
46 years old

gasyz

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Re: THR but want BHR
« Reply #17 on: November 07, 2013, 05:00:43 PM »
As far as I can tell from reading this forum the main failure reason is bad fitment,and it also seems that BHR are by far the safest product.So if I  can get Mr Treacy to fit a BHR the odds should be in my favour.If it goes wrong then I can fall back on a THR,but I think it's worth the gamble(hopefully)
Rbhr 60/54
Ronan Treacy, 5th September 2015

Jaks111

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Re: THR but want BHR
« Reply #18 on: November 07, 2013, 09:40:20 PM »
Hi I had a resurfacing done with mr treacy  at the ROH on the 11th September 2 months ago? I feel you must be local I went to heartlands and Solihull hospital, they don't do resurfacing I then went to ROH and seen a lovely mr revell who convinced me in a nice way to have a replacement I agreed, as he did not do HR i came home and thought omg what have I done I then called the hospital and cancelled, and did some more research after a phone call to the McMinn centre to cut a long story short there and then I decided I only wanted mr treacy, so my doctor was great and re referred me again so I actually seen 4 surgeons and went to 3 hospitals, do your homework.

Ps Danny will be along soon, he actually had surgery as well with mr treacy.
The hardest I'm finding is the recovery, today I have had a long walk spent 2 hours in the swimming baths gentle swimming, then half hour in the easy gym yet I'm suffering still with the pulling/ stiffness in the hip it's just not getting any easier.  But I am walking faster.
But I'm trying
Good luck
Jackie

Anna

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Re: THR but want BHR
« Reply #19 on: November 09, 2013, 01:13:15 AM »
Hi, there's been some good advice given here. Don't rush into anything.

They are trying to ban giving BHR's on the NHS because of a high failure rate (due to the surgeons who do not know what they are doing!). Most surgeons will not perform them. Mr Treacy I'm pretty sure is still doing them on the NHS at the minute so go get your ass to see him!! He is the best surgeon in the UK for BHR's and I would listen to his opinion. I had my heart set on a BHR and my local surgeons dismissed it straight away telling me about metal levels. I was not happy with their advice and booked myself a private appointment with Mr T. I am so glad I did because his opinion is just the best. He told me I was not suitable for a BHR because of the angles of my hips. I was gutted as I would have jumped at the chance of resurfacing so I could continue with my sports, but on the other hand, if Mr T says no, then it's a no. That appointment confirmed to me in my mind that I had no option but to go for a THR and I needed that confirmation so I would have no regrets. To know that what route I was taking was the best and that I had explored all options. If I could, I would have had a BHR. As others have said, its like a second lifeline. If it goes wrong, you just revise it to a THR. I think you have definitely made the right decision to see Mr T and he is such a lovely man. He will be honest with you.

On the other hand, I just want to say that I had my THR 3 months ago. I absolutely love mountain biking, skiing, horse riding and any other daft sport that involves speed, heights and danger. Yesterday I spent the day mountain biking for about 15 miles along some single tracks and today I went road riding. Although I am currently not doing anything dangerous or risky, I feel really good. My surgeon has told me that I have no restrictions whatsoever other than he wouldn't recommend lots of marathon running as it will wear the implant out faster. I have a ban of any risky sports till 6 months, at which point he said he will be perfectly happy for me to go skiing and 'proper' biking and start having some fun. If, for whatever reason Mr T says no to the BHR, life with a THR will still be great. THR's have come on leaps and bounds and they are not as restrictive as people make out. I put off my op for a long time because I didn't want to give up my biking but it turns out, I don't have to. My THR was the best decision I have ever made.

Good luck with your appointment

Anna
RTHR - 08/08/2013 -Mr johan witt, London

 

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